


Outside Her Speciality

by compo67



Series: Punzel Verse [29]
Category: Supernatural RPF
Genre: Blood, Doctors & Physicians, Families of Choice, Family Feels, Gen, HIV/AIDS, Hospitalization, Hospitals, Inspired by Poetry, Light Angst, Medical Procedures, Medical Professionals, Nurses & Nursing, POV Outsider, Parenthood, Poetry, Sibling Bonding, Timestamp
Language: English
Status: Completed
Published: 2017-08-04
Updated: 2017-08-04
Packaged: 2018-12-11 00:30:03
Rating: Mature
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 3,824
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/11703021
Author URL: https://archiveofourown.org/users/compo67/pseuds/compo67
Summary: Linda’s speciality lies in obstetrics and gynecology.She went to the University of Iowa for a dual degree in Biology and Chemistry, and graduated with honors and distinction. After a gap year working at Doctors Without Borders, she obtained her MD degree at Northwestern University in Chicago. From there, she took on Baltimore and completed her residency at Johns Hopkins, where she was chief resident.Years later, she accepted an appointment at the Anaheim Memorial Hospital. She intended to stay two or three years and move on. What actually happened was much, much different.





	Outside Her Speciality

Linda’s speciality lies in obstetrics and gynecology. 

She went to the University of Iowa for a dual degree in Biology and Chemistry, and graduated with honors and distinction. After a gap year working at Doctors Without Borders, she obtained her MD degree at Northwestern University in Chicago. From there, she took on Baltimore and completed her residency at Johns Hopkins, where she was chief resident. 

While at Johns Hopkins, she received the award for outstanding resident in Gynecologic Endoscopy from the American Association of Gynecologic Laparoscopists. From there, she worked at Duke University and earned first prize at the Charles Hammond Research Day, plus grant funding for research. 

Two years later, she moved to Boston and settled into Massachusetts General. The East Coast suited her. She enjoyed the weather, the culture, and the availability of different committee appointment, memberships, and offices. Winter didn’t bother her. She grew up in Montana and knew how to shovel herself out of walls of snow and still make it to work on time. 

In her late-thirties, that all changed.

Stanford called.

For two weeks, she negotiated salary, terms, and benefits. If they wanted her, they had to act like it. If they wanted her research, they had to fund it. 

She left Massachusetts on a Friday evening and started work at the Hsueh Lab at Stanford on Monday.

Her research team was divine. She led a team of six, looking into the hormonal basis of follicle recruitment and differentiation, oocyte/granulosa cell communication. In the eighteen months of research, she wrote and published three different papers in The New England Journal of Medicine, The Lancet, and JAMA. 

But she missed hospital settings. 

Clinical trials and research studies didn’t offer enough one on one time with patients. And though she loathed how health insurance had grown into a bloated leech on the most disadvantaged, she learned how to navigate the system. 

Through her connections, she put the word out that she was looking for a hospital appointment. 

Offers arrived from across the country. She did the most research on and communication with hospitals based on the East Coast. 

Until a relatively small hospital--small in comparison to her background--contacted her about an appointment five hours south of Palo Alto. It caught her attention by its high turnover rate, dismal patient satisfaction, and bleak ratings in comparison to other hospitals in a fifty mile radius. 

It seemed like a challenge.

She had intended to stay for two or three years, make her mark, set standards high, and move onto the next hospital. Anaheim Memorial had a heavy case load, a high number of low-income patients, and a salary that would have made many of her colleagues at Stanford laugh. 

Two to three years turned into six. 

At about three in the afternoon on a Thursday in October, Linda met with one of the social workers from the county. They brought her ten files of high-risk, low-income, and struggling individuals with various backgrounds and medical needs. She selected six to take on as patients at a reduced rate negotiated between the county, the hospital, and Linda. The social worker discussed each of the six files in depth while Linda took notes. 

Three days later, she saw her first patient of those six.

He looked as hungry, scared, and hurt in person as he did in his case-file photograph.

Years and years after, Jared looks just like that hungry, scared, and hurt eighteen year old. He paces in the hospital hallway, biting his nails, eyeing every staff member with suspicion, his movements quick, nervous, and abrupt. 

Linda’s specialty lies in obstetrics and gynecology. 

Jared looks up and sees her, files in hand. He rushes over, this patient of hers from her time at Anaheim Memorial. More than once, she bought him a plate of waffles at the diner nearby. He looks at her the same way he did after their first appointment together when she told him he and the babies would be okay. 

Like the world is ending, he hugs her and lets go of a breath he must have been holding for hours. “I’m so glad you’re here.” 

“I’m glad to be here,” she answers, patting his shoulder after their hug. “Hannah is bringing over clothes and supplies in a little bit. I’ll go check in with the folks around here. Is there anything I can get you?”

“No,” he blurts out, tears pooling. “No, you’ve done enough just being here.”

“Don’t be silly. I’ll get you some water. Maybe something to eat. You must be exhausted.”

“I…” Jared has never been a small person--in size or personality. But in this hallway, under the flourescent lights of the UCLA Medical Center, he looks about the age of his own three children. Lost and completely overwhelmed. He tugs on her white coat. “Why didn’t he tell me sooner?”

She’ll check in with the nurses first. Nurses make the world go round. They’ll have all the updated information and stats, plus a good idea of whoever is on floor and about to rotate out. There are a series of procedures and red tape she needs to complete or work around, but while this isn’t her floor, this is her hospital. It has been for the past five years. She moved with Hannah to Santa Monica, to be closer to the three grandchildren Hannah hadn’t planned for but received with open arms. 

Private practice life is different than research life or hospital appointment life. But she falls back into it without hesitation. 

“Listen to me,” she says to Jared, hands on his shoulders. “You’re going above and beyond right now. I need you to conserve your energy and focus on what matters most. We’re all here now and that’s what we’ve got to work with.” She hugs him again and squeezes his hand. “I’ll bring you some water and a sandwich in a second. We filled out paperwork, yes?” 

He nods and squeezes her hand. “Yes. Everything you asked for we signed.”

“Great. I’ll go wrestle the nurses. Ham or turkey?”

“I’m okay.”

“Turkey it is.” 

On the way to the nurse’s station, Linda quickly texts Hannah. It’s best to hold off on the reinforcements for now, while Tristan is in the ICU. Clothes and food would be appreciated at this time. The turkey sandwich isn’t going to last long, and Linda has a feeling Jared won’t agree to going to the cafeteria any time soon. 

There are a lot of nurses and doctors who see their patients as numbers. The modern medical profession has, after all, become a numbers game. How many patients can you see in an hour? How many referrals? How many claims? Things have become less about treating the patient and more about treating insurance companies to red carpet status. 

ICU staff, however, can usually be counted on to care. 

Linda checks in with the head nurse on duty. ICU nurses don’t fuck around. Maggie works three steps ahead of everyone in the unit. After a quick adjustment to her hijab, she shakes Linda’s hand and gets to business. She’s got vitals, a medications list, health histories from two HIV/AIDS clinics, and a summary of what landed Tristan in the ICU. The social worker will be around within the hour. The ICU doctor, Dr. Cheng, has already seen Tristan and will discuss treatment plans with Linda.

“His heart rate,” Maggie points out, sharing her iPad screen with Linda, “is troubling. One eighty when he got here. BP is up.”

“Any labs?” 

“Some. Still waiting on others.” Maggie swipes to a different screen. 

“Hemoglobin at a four,” Linda murmurs. “Liver and kidney function?”

“Right here. He’s dehydrated and malnourished. Beth wants to interview the brother.”

“Now is not the best time. Can I get copies of these? Do we see any signs of pneumonia?” 

“Lungs are clear. Oxygen is low.” Nearby, a red phone rings. Maggie hands Linda the iPad. “Excuse me, I’ll be right back.” 

The entire ICU staff works in a swift and efficient rhythm. They are experts at making it seem like nothing urgent or catastrophic is happening. In reality, every single body in every single bed is fighting a life-threatening injury or illness. From complications in surgery, accidents, infections, breathing problems, to massive blood loss, ICU staff focus on critical care. 

Dr. Cheng arrives not long after. She looks familiar--petite, round glasses, black hair pulled back in a neat and tidy ponytail. “Pleasure,” Linda says, shaking her hand. “I remember you from the Clinical Therapeutics and Biomedical Prevention seminar last year.” 

With a smile, Dr. Cheng nods. “Yes. Good to see you. Not in great circumstances though.” She slips on a different pair of glasses, blue in color. “Let us talk about this young man.”

From the nurse’s station to Tristan’s room, Dr. Cheng provides a clear, thorough summary of her evaluation and recommended treatment. She’d like to have her colleague, Dr. Lake, weigh in on further treatment options. Dr. Lake specializes in HIV/AIDS treatment and complications; they could use her expertise here. Linda agrees and signs off on the next few steps. 

They find Jared at Tristan’s bedside, holding his hand. 

Tristan doesn’t open his eyes at the sounds of their voices. Linda scans the machines he’s hooked up to, committing to memory his vitals at this point in time. 

The man looks awful.

“Mr. Padalecki.” Dr. Cheng addresses Jared. “We have discussed what needs to be done immediately. Your brother needs a transfusion in order for us to proceed.” 

Jared looks to Linda for confirmation. Linda nods. 

“Do you need my blood?” Jared places both hands over Tristan’s. “I can do it, right?”

Dr. Cheng yields to Linda to explain. “You can. You’re identical twins, it would work. But it’s going to be faster for us to order it than it would be for you to give it. And we’re not talking about a small amount here. We just need his and your consent to start. We need to act fast.”

With care, Jared stands up and leans down towards Tristan. He doesn’t let go of Tristan’s hand while he whispers into his ear. Tristan stirs, his breathing labored. How on earth he made it this long without collapsing is beyond Linda. He says something that makes sense to Jared, who translates it to Dr. Cheng and Linda as a tentative yes. Dr. Cheng immediately springs into action. She pages Maggie and another nurse. Linda gives Dr. Cheng and her team room, standing next to Jared. A call is placed for Dr. Lake. The soonest she can stop by is later this evening. For now, they’ll proceed according to Dr. Cheng, with Linda’s input. 

While Maggie and Dr. Cheng prep Tristan and delegate, Linda pulls Jared aside. The ICU rooms are larger than other rooms in the hospital, but feel smaller due to the amount of equipment available. 

She hands Jared a smuggled turkey sandwich and orders him to eat it while she explains what’s happening. In order to drive home the necessity of eating, Linda uses the tone of voice she hears Hannah use with the grandchildren at dinnertime. Out of exhaustion or the tone, Jared relents, unwraps the sandwich, and takes tiny bites. 

“We have to do our best to make sure he doesn’t catch anything while he’s here. That’s going to limit the number of people he’ll be able to see and place restrictions on you going in and out. To be on the safe side, we would like to see you in scrubs. The nurses will provide you with a fresh pair every twelve hours. Change out of them if you’re going to the cafeteria and back into them when you come back. Wash your hands frequently and thoroughly. An infection could set him back and we’re already in deep.” Linda pauses. “We’re good?” 

Jared nods. “Yes. Good. I… I need to talk to the guys about the kids.”

“We’ll handle that later. Right now, the most pressing concern is his hemoglobin level. The transfusion should help, but it’s not going to be instant, and we need to keep him stable until then. His liver has taken a hit, but I’m not sure what that means in the big picture.”

“Why is all this happening?” Jared finishes most of the sandwich. He never looks away from Tristan. “Is this the HIV or has he been… I don’t even know how to finish that sentence.” 

Dr. Cheng leaves for the moment, summoned to a different room. Maggie stays with another nurse and they go over paperwork with Tristan, speaking soft and slow. They need his signature while the blood is ordered and brought up. Jared stands and goes over to them. He places his hand over Tristan’s and helps him sign his name. Tristan fidgets in bed, weakly moving, and Jared murmurs for him to mind the IV and the oxygen line. In a few seconds, Jared hones in on the cause of Tristan’s discomfort--without needing words or hand motions. 

He adjusts the angle of Tristan’s bed and removes one of the pillows from his head. He adds it to Tristan’s feet and smooths out the blanket, carefully rearranging different lines and tubes. 

Linda remembers once watching Kaylee tuck in her dinosaur doll--the one with a tiara hot glued to its head--and take its temperature. Her small hand pat its green arm. She can practically hear Kaylee say, in her slight drawl, “You’ll feel better soon. I’m here to be your doctor.” 

Nevermind that two seconds after, Hannah announced snack time and the patient was abandoned and forgotten in favor of popsicles and strawberries. 

This is what it is to have siblings, children, and grandchildren. 

Tristan closes his eyes when Jared is near. When others come in and out of the room, he almost always has his eyes open. Linda wonders if he noticed the red mark on his hospital bracelet identifying him as HIV positive, or the red square tacked onto the door. 

She doesn’t blame him for being wary of the staff or her.

“You can keep talking,” Jared murmurs, his voice hushed. “I think he needs to hear it.”

Linda keeps her summary brief. From what Jared has told her and his charts, it seems likely that this has all come to a head due to poor medication adherence and the mutation of the strain. Mutations are very common in HIV because it replicates at an extremely rapid rate. But if Tristan wasn’t taking his medications as prescribed, and the strain mutated, then the drugs would have been less effective or completely ineffective. Linda theorizes that the blood loss that rendered him so weak is due to the side effects of one of the medications. 

In a perfect world, Tristan should have reported these side effects early on--nosebleeds, coughing up blood, peeing blood, poor clotting in any wounds or cuts--and switched medications under the care of a specialist. In a perfect world, he would have been able to afford all of those medications without any problem and adhered to the regiment so the strain had less chance of overwhelming him. 

In a perfect world, Linda wouldn’t watch Jared wipe away at the tears in his eyes, always maintaining at least one hand on Tristan. 

The blood transfusion will help some. The team will monitor him for allergic reactions like chest or back pain, a fever, low blood pressure, or a rash. Or worse--acute immune hemolytic reaction, delayed hemolytic reaction, and Graft-Versus-Host disease. For those reasons, they won’t do all four necessary packs at once. It will take hours and incredibly careful monitoring. In the meantime, they’ll run more tests and Dr. Cheng, Dr. Lake, and Linda will have a consult. Tristan’s labored breathing gives cause for concern; respiratory failure is high in HIV patients. No one wants this to develop into pneumonia. All of this has to be done in a careful balance--taking precaution to keep the staff and Tristan safe. Linda holds concerns for drug interactions.

She has to trust Dr. Cheng and Dr. Lake just like everyone else under their care and expertise. 

Maggie arrives with a tech, wheeling a cart. Her business demeanor fades as she speaks to Jared and Tristan about what they’re about to start. 

“Let’s start with sandwiches and Jell-O.” She holds both up. “The good thing about a transfusion is that you get to eat one or the other while we’re doing the first pack.” She shows off each one ala Vanna White. “Here on the left you have the tasty option of turkey and swiss, with light mayo and mustard on wheat bread. On the right, you have the delicious option of cherry Jell-O, always a patient favorite.” 

Tristan refuses to or can’t respond. He shuts his eyes. 

“I think your brother had the turkey,” Maggie continues, her tone never faltering in its kindness. “So we’ll let you try out the Jell-O. Now, I can do airplane noises if you need them, I used to work pediatrics. But I also need to get this transfusion started so let’s say we have brother help out. Brother?” 

Jared nods and takes the Jell-O and plastic spoon offered. He opens it in the same way he’s opened thousands of snacks or packets for the kids. Linda remembers when the triplets were just starting to eat solids. It was Hannah who introduced the idea of modeling behaviors. 

“There’s not much here,” Jared says to Tristan. He sits on the edge of the hospital bed. “Four or five spoonfuls and I’ll finish it off after.” 

Linda has treated HIV positive and AIDS patients before. She’s worked with HIV positive doctors, surgeons, nurses, and techs. Inside hospitals and research labs, HIV brought a roaring, tremendous change--at a high price. 

It swept through and overwhelmed everyone. 

It robbed communities of the everyday. Of running errands, driving, parking, hurrying along for a cup of warm coffee, handing over cash, meeting friends, bounding home, unbuttoning a coat, throwing it onto a chair, relaxing into the embrace of lovers or armchairs, complaining about the bills, the rent, the news, the cold, the heat, the next day and the day after and the day after and the day after that.*

Instead of the everyday it brought ambulances, blood pressure cuffs, plastic bags of IV fluids, butterfly needles, oxygen tubes, catheters, forearm IVs, backless gowns, CD4 cell counts, protease inhibitors, fusion inhibitors, NRTIs, NNRTIs, CCR5 Antagonist, fixed-dose combinations, viral loads, diminished self, extended self, pained self, the eternal drilling of needles here, there, everywhere, tests, bills, daunting staircases of paperwork covered in bureaucratic red tape just to cover a dime here and there, the suspension of dignity, the voices of onlookers, well-wishers, and strangers, and premature, brutal--disappointment, displacement, death.**

Jared scoops a spoonful of Jell-O and eats it. “It’s good,” he announces. “Kinda cold.” 

The next spoonful goes to Tristan. 

When the kids were small, Linda remembers applesauce and mango chunks strewn around high chairs, floors, faces, and hair. More than once, she had a spoon smacked out of her hand by a surprisingly strong little one. And more than once, she watched Jared pick up a preselected baby, messy with food, and blow raspberries on their tummy, then plead and plead and plead for them to please, please, please eat. 

“Cherry’s good,” Jared tries, his voice wavering. “Unless you want the sandwich. We can try the sandwich. I’ll take the tomato off.” 

Maggie sets up the transfusion. She motions to Linda to join her outside for a moment. 

On her way out, Linda pats Jared’s shoulder. He’s doing the best he can. 

In the hall, Maggie relays what to look out for in the next hour. She knows Linda knows. Linda thanks her. They talk hospital for a moment. One of the techs can bring her and Jared dinner from the cafeteria. Linda thanks her, but declines. Hannah will bring them something to eat, most likely soup and grilled cheese sandwiches. 

“Did you want one of each?” Linda offers. 

“It wouldn’t put her out?” 

“Not at all. Knowing her, she is more than likely bringing extra.” 

Laughing softly, Maggie nods. “Okay, then yes. I would love a grilled cheese. I haven’t eaten in… well, you know the drill.” 

“Most of it. ICU is a different beast.”

“I love it,” Maggie says with a smile. “Most of the time.” 

A nurse approaches with questions, followed soon after by a tech. The hum of the ICU goes on around them, unstoppable, constant. It reminds Linda of her first few weeks in residency. Seventy-five percent of the time she was exhausted. The remaining twenty-five, she was utterly, completely happy. Over the years those percentages fluctuated. She never stopped working. Twelve. Fourteen. Sixteen hour shifts. Same in the labs. Same in the hospital. Same in private practice. 

Helping raise children and grandchildren seems to be incredibly similar. 

She ducks back into the ICU room marked with a red square on the door. 

Jared’s voice sounds out, steady and warm, just like it sounds at three in the morning when there are nightmares or fevers or worries or drinks of water. He brushes a piece of Tristan’s hair away from his forehead, just like when there are flus or colds or sniffles or allergies or stomach aches or yucky days.

“Come soldiers of joy, doormen of truth. Come, true-of-heart.”

He feeds Tristan a spoon of wobbly, red Jell-O. 

“Know this: my heart was too big for my body so I let it go. But believe me when I tell you my soul somehow still squeezes into narrow spaces.”

Another spoonful. 

“Place your hand beneath your head when you sleep tonight and you may find it there making beauty as we sleep.” 

He wipes away a smidge of Jell-O from the corners of Tristan’s mouth with his thumb, without hesitation. 

“Your hands are like my heart. Some days all they do is tremble.” 

Another spoonful. 

“I am like you. I too at times am filled with so much fear.” 

Jared stares at the empty spoon. He inhales. Exhales. Carries on. Twelve. Fourteen. Sixteen. Twenty-four hour days. Another spoonful.

“But like a hallway, must find the strength to walk through it. Walk through this with me. Through this church that is ours--this church of bone birthed of blood and muscles.” 

Tristan opens his eyes and looks up at Jared. He keeps his eyes open through another spoonful and another line. 

“There is a doorknob glowing like chance. Clutch it. Turn and pull. Step through. Chin up. Back straight.” Jared offers a small, shy smile and the last spoonful of Jell-O. “Eyes open. Hearts loud. Walk through this with me.” 

Linda moves, quietly, to leave.

She hears a response. 

“Walk through this with me.” 

She will never regret accepting that appointment at Anaheim Memorial. 

**Author's Note:**

> phew. i feel like wow. feels. hopefully i have succeeded in what i set out to do with this. it's odd not having jensen in a Punzel installment. i tried very much to remain accurate with the medical stuff, but I've only been in the ICU and in hospitals as a patient. nurses and ICU staff are amazing people though. <3
> 
> i'm too impatient to wait for my betas to take a look at this and i make poor decisions at 2AM. XD excuse the errors. comments are love!
> 
> * = inspired by "What the Living Do" by Marie Howe
> 
> ** = inspired by "RIP, My Love" by Tory Dent
> 
> poem quote by jared at the end = "Closer" by Anis Mojgani


End file.
